Provider Demographics
NPI:1558353227
Name:CLEMENS, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:243 111TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6308
Mailing Address - Country:US
Mailing Address - Phone:425-502-8660
Mailing Address - Fax:
Practice Address - Street 1:12360 LAKE CITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5447
Practice Address - Country:US
Practice Address - Phone:206-384-4382
Practice Address - Fax:206-440-3137
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKMD11783207Q00000X
WAMD 60137713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK080085487OtherRAILROAD MEDICARE
OK731297740002OtherBLUE CROSS BLUE SHIELD
OK5300256OtherAETNA EDI
OK100110620AMedicaid
OK080085487OtherRAILROAD MEDICARE